TY - JOUR
T1 - Triage of mild head-injured intoxicated patients could be aided by use of an electroencephalogram-based biomarker
AU - Michelson, Edward
AU - Huff, J. Stephen
AU - Garrett, John
AU - Naunheim, Rosanne
N1 - Publisher Copyright:
© 2019 American Association of Neuroscience Nurses.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Objective: Drug and alcohol (DA)-related emergency department (ED) visits represent an increasing fraction the head-injured population seen in the ED. Such patients present a challenge to the evaluation of head injury and determination of need for computed tomographic (CT) scan and further clinical path. This effort examined whether an electroencephalogram (EEG)-based biomarker could aid in reducing unnecessary CT scans in the intoxicated ED population. Method: This is a retrospective secondary study of an independent prospective US Food and Drug Administration validation trial that demonstrated the efficacy of (1) an automatic Structural Injury Classifier for the likelihood of injury visible on a CT (CT+) and (2) an EEG-based Brain Function Index to assess functional impairment in minimally impaired, head-injured adults presenting within 3 days of injury. Impact on the biomarker performance in patients who presented with or without DA was studied. Results: Structural Injury Classifier sensitivity was not significantly impacted by the presence of DA. Although specificity decreased, it remained several times higher than obtained using standard CT decision rules. Furthermore, the potential to reduce the number of unnecessary scans by approximately 30% was demonstrated when the Structural Injury Classifier was integrated into CT clinical triage. The Brain Function Index was demonstrated to be independent of the presence of DA. Conclusion: This EEG-based assessment technology used to identify the likelihood of structural or functional brain injury in mildly head-injured patients represents an objective way to aid in triage patients with DA on presentation, with the potential to decrease overscanning while not sacrificing sensitivity to injuries visible on CT.
AB - Objective: Drug and alcohol (DA)-related emergency department (ED) visits represent an increasing fraction the head-injured population seen in the ED. Such patients present a challenge to the evaluation of head injury and determination of need for computed tomographic (CT) scan and further clinical path. This effort examined whether an electroencephalogram (EEG)-based biomarker could aid in reducing unnecessary CT scans in the intoxicated ED population. Method: This is a retrospective secondary study of an independent prospective US Food and Drug Administration validation trial that demonstrated the efficacy of (1) an automatic Structural Injury Classifier for the likelihood of injury visible on a CT (CT+) and (2) an EEG-based Brain Function Index to assess functional impairment in minimally impaired, head-injured adults presenting within 3 days of injury. Impact on the biomarker performance in patients who presented with or without DA was studied. Results: Structural Injury Classifier sensitivity was not significantly impacted by the presence of DA. Although specificity decreased, it remained several times higher than obtained using standard CT decision rules. Furthermore, the potential to reduce the number of unnecessary scans by approximately 30% was demonstrated when the Structural Injury Classifier was integrated into CT clinical triage. The Brain Function Index was demonstrated to be independent of the presence of DA. Conclusion: This EEG-based assessment technology used to identify the likelihood of structural or functional brain injury in mildly head-injured patients represents an objective way to aid in triage patients with DA on presentation, with the potential to decrease overscanning while not sacrificing sensitivity to injuries visible on CT.
KW - EEG
KW - TBI
KW - brain electrical activity
KW - brain function index
KW - drug and alcohol intoxication
KW - quantitative electrophysiological measures
KW - structural brain injury
KW - structural injury classifier
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85062408386&partnerID=8YFLogxK
U2 - 10.1097/JNN.0000000000000420
DO - 10.1097/JNN.0000000000000420
M3 - Article
C2 - 30649089
AN - SCOPUS:85062408386
SN - 0888-0395
VL - 51
SP - 62
EP - 66
JO - Journal of Neuroscience Nursing
JF - Journal of Neuroscience Nursing
IS - 2
ER -